Healthcare Provider Details

I. General information

NPI: 1861546038
Provider Name (Legal Business Name): LAWRENCE SCOTT SMITH DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

813 COLUMBIA ST
POMEROY WA
99347-0099
US

IV. Provider business mailing address

PO BOX 99
POMEROY WA
99347-0099
US

V. Phone/Fax

Practice location:
  • Phone: 509-843-3495
  • Fax: 509-843-3496
Mailing address:
  • Phone: 509-843-3495
  • Fax: 509-843-3496

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDE00004987
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: